NI Theories and Models

Chapter 2.

What is Nursing Informatics?

     It is defined as the combination of computer science, information and communication technology and nursing science to enhance nursing informational processes in the field of care, administration, research and education.It deals with the study of how healthcare data, information, knowledge and wisdom.

     Conceptualization of automated nursing information process may have started as early as late 1950s in the US. In the 1960s computers found its way in automating accounting and business functions. Attempts in addressing clinical applications was unsuccessful because of computers' high price and inflexibility.

     1963, Mary Ann Bitzer wrote a simulation program about obstetric nursing, which were used for teaching students.

      1970s, in the West, many projects were done regarding use of computers in nursing.

     1985, Marion Ball and Kathryn Hannah presented in their paper in a nursing journal the use of nursing informatics in many nursing process. They defined nursing informatics as use of information technologies in relation to those functions within the purview of nursing that are carried out by nurses when performing their duties.

     In 1986, Blum grouped and classified computers into functions as to whether the specifically process data, information or knowledge.

     In early 1989, Judith Graves and Sheila Corcoran using Blum's model in classic article, "The Study of Nursing Informatics", proposed that nursing informatics is a combination of computer science, information science, designed to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care. It made use of an information model known as data-information-knowledge continuum.

     In the late 1989, Irene Joos and Ramona Nelson added wisdom to the continuum where one combine his personal, social, ethical, moral, cultural and other values with one's knowledge and experience to solve complicated problems.

     In 1992, the American Nurses Association (ANA) recognized nursing informatics as specialty.

     In 1996, Goosen included in Graves and Corcoran's definition thinking that is done by nurses to make knowledge-based decisions and inferences for patient care.

Theories in Nursing Informatics.

A. Change Theories
     -Unplanned
     -Planned

1. Roger's Diffusion of Innovation Theory (Unplanned change)

     This theory examines the pattern of acceptance that innovations follow as they spread across the population of people who adopt it. Adopters are divided into 5 categories:

• Innovators (2.5%). They readily adopt the innovation, often seen as troublesome and are not able to sell other on the innovation.
• Early adopters (13.5%). Acts as promoters for the innovation.
• Early majority (34%). Averse to the risk of innovation but are willing to make investments.
• Late majority (34%). Adopts innovation because of peer pressure.
• Laggards (16%). Suspicious about the innovation

2. Lewin's Change Theory (Planned change) 

     3 stages:

• Unfreezing. Making use of processes that reinforces an individual's involvement in the change, having their opinions respected.
• Moving. This process should be supported by the administration. Users be provided with adequate training.
• Refreezing. The planned change become the norm.

B. Information Theories

1. Blum's Theory

     Blum stated in 1986 that computer functions can be categorized into 3 groups: One where data is processed, information is processed and one where knowledge is processed.

2. Data-Information-Knowledge-Wisdom Continuum

     Graves and Corcoran based the theory on nursing informatics on data, information and knowledge as initiated by Blum.

• Data are elements that are uninterpreted and plainly recorded and viewed as is like vital sings, patient's billing and lab results.
• Information comprises interpreted data based on one's capacities, attitude and behavior.
• Knowledge is an organized collection of information.
• Wisdom considers the use of ethical, moral, personal, social, cultural, religious, political and other values in decision making.

C. Cognitive Theories

     Cognitive science includes mental models, skill acquisition, perception and problem solving that adds an understanding of how the brain perceives and interprets a computer screen.

Some applications of NI theories.

Automating data entry. Most businesses encounter data input requirements that can be time consuming. Instead of spending mundane hours entering data, you can simply rely on automated data-entry to finish the task for you in a fraction of the time. Automated data-entry is capable of understanding a variety of forms and entering information into databases with little to no mistakes. It does not require as much human input as manual data-entry would and is therefore cheaper. 

Sharing of information through network systems. The actual interpretation of data involves individual cognitive process to give meaning and become information.

Knowledge bases and decision support system. Knowledge is built from information as information is built from data. An organized collection of interrelated information regarding a particular topic refers to a knowledge base. This places knowledge above information.

A knowledge base is not a merely collection of information but rather formed from interrelationship between the pieces of information. Decision support systems are systems that process information by comparing a selected or an entered data against a standard set of information known as a knowledge base.

Wisdom and expert systems. Wisdom allows a clinician to use ethical, moral, social, cultural, religious and personal values to solve difficult problems. An expert system is a knowledge based system with built-in procedures for determining when and how to use that knowledge.

Introduction to Nursing Informatics

Chapter 1. Introduction to Nursing Informatics

Origin of healthcare informatics

     For decades, in healthcare, the increase in knowledge has led to the development of many specialties and subspecialties. It is a new knowledge domain of computer and information science, engineering and technology in all fields of health and medicine, including research, education and practice. It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tool include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health, occupational therapy, and (bio)medical research. There are many data that can't be easily understood if not merged and analyzed thoroughly using only the data that we have and the knowledge that we already have. This led to the development of healthcare informatics.

Nightingale emphasized documenting health

     In the mid 1800s, Florence Nightingale used a documentation system in the way of how to treat wounded soldiers in the Crimean war. She documented every interventions and outcomes to compare them and pick out the best interventions to apply. She was known and recognized as the first public health informaticist.






Nurses have serious problems in the workplace.


     With this unending development of our technologies, we already have many new devices that nurses use. Thus, healthcare teams faces challenges in learning this new devices on how to use them for the sake of treating people. the top 4 problems of local nurses in the workplace are:

1.) Documentation time is excessive.
     With nurses caring 10 patients or more at a time, it is difficult and takes time to make a documentation for them. So, majority of the nurse's time is eaten up in facing the computer to document than having conversations to the patients.

2.) Turnaround time is too long.
     The request that was made is accomplished in an unideal time. This is because procedures or laboratory tests are long, this may be because of overworked hospital aides who carry out order slips. Even with the availability of modern equipment, there will still be a delay because of the large volume of results that needs to be read.


3.) Nursing processes are inaccurate.
     Even if modern equipments are available in assisting nurses to care for the patients, errors are still committed. Medication errors runs first, second is labeling errors and common are wrong entries, dictation, translation and transcription of orders of information. Automation of these processes leads to reduction of errors.


4.) Communication is poor.
     Communication is poor when between healthcare providers and between departments uses telephone, this is because it requires for both parties to be present. Another disadvantage would be telephones can be tapped or bugged when security systems are breached. So computers provide different modes of communication like videoconferencing, chat, email or text-messaging which is more convenient and appropriate.

     




Automation can save nurses because automation largely reducts paper works, shortening turnaround times, improvement of accuracy of nursing processes and eliminates time consuming and redundant processes.